Organization
MARY R. STOCK, PHD, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY R STOCK PHD, LCSW (LICENSED CLINICAL SOCIAL WORKER)
(228) 216-0130
Entity
Organization
Contact information
Practice address
4423 LEISURE TIME DR, DIAMONDHEAD, MS 39525-3221
(228) 216-0130
Mailing address
PO BOX 1144, KILN, MS 39556-1144
(228) 216-0130
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C2936
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811153042
NPI
—
Enumeration date
07/17/2010
Last updated
07/17/2010
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